Below are links to resources to help you understand your health insurance plan. Be sure to bookmark this page and refer to it often. More information is also available on Self-Service—logon today.

Member Handbook Kit✝

Your Member Handbook kit makes your health insurance plan easier to understand and use. It explains what’s covered and how to get care. | Learn More

Rx Drug Benefits

If your employer offers prescription drug coverage through BCNEPA, your plan may have either the multi-tiered or coinsurance program. These programs help keep your drugs affordable because they use aformulary. | Learn More

Need more information? Email Customer Service through Self-Service or give us a call at 1.888.345.2346 or (TTY) 1.866.280.0486, weekdays, between 8 a.m. and 5 p.m.

*If your plan is self-insured, be sure to read this version of Your Blue Book to see how Blue Cross of Northeastern Pennsylvania works with your plan sponsor for the best coverage and benefits. Check with your employer or plan administrator to see if you have a self-insured plan.

✝Policies and provisions described in the documents referenced here may not apply to all self-insured group plans.

BlueCare QHD Custom PPO uses the Custom PPO network. Using in-network doctors and hospitals for all covered medical care and services will always save you money, because your costs for care are the lowest in-network.

You also have coverage for care from Blue Distinction Centers for Transplants® and several hospitals and their participating doctors, located just outside our 13-county service area—at the same low in-network cost for care.

BlueCard PPO doctors and hospitals are out of the network with your Custom PPO plan. You can use BlueCard PPO providers, but at a higher out-of-pocket cost for care.

You have coverage for care outside of the Custom PPO network, but at a higher out-of-pocket cost. Doctors and hospitals out of the Custom PPO and BlueCard PPO networks do not accept our discounted “allowable charge” as payment in full. They may bill you for a bigger share of the cost for your care.